How Sick is Your Child?

If you are a parent, it's inevitable that your child will suffer from diarrhea, vomiting or both at some point during their life. But how do you know when it's serious-and how do you treat it?

Below, Dr. Daniel Neuspiel, Associate Chairman of Pediatrics at Beth Israel Medical Center, and Dr. Steven Schwartz, Professor of Pediatrics at SUNY Brooklyn and Chairman of Pediatrics at Long Island College Hospital, discuss these common childhood ailments.

Let's start off with a basic question. What is diarrhea?
STEVEN SCHWARTZ, MD: Diarrhea is a change in frequency or consistency of stools from a child's normal pattern. And that varies from child to child. One of the things that parents have to learn as their child grows up is that what's normal for one child is not necessarily normal for the other. Another important point to remember is that a change in pattern may or may not be associated with other kinds of symptoms, such as fever or other problems.

If there's a question as to whether the child is experiencing diarrhea, I always recommend that the parents ask the pediatrician or their family doctor.

What role does the age of the child play in the seriousness of diarrhea?
STEVEN SCHWARTZ, MD: If an older child develops diarrhea, we can be pretty certain it is diet-related, or perhaps there is an intestinal infection, typically viral. In a young child-particularly an infant under six months of age and certainly an infant under two to three months of age-diarrhea can just be one of the symptoms of far more serious illness. So if a parent sees diarrhea in a young infant, their physician should be contacted immediately.

DANIEL NEUSPIEL, MD: I would add that in a young infant, not only is the cause potentially different, but the consequences of diarrhea can be dramatically different. A young infant can lose fluids very rapidly, therefore becoming dehydrated more easily than an older child.

Is it fair to say it can be life threatening-that diarrhea is more than just a watery stool that's inconvenient?
DANIEL NEUSPIEL, MD: Yes. And it's often managing fluid loss and preventing serious dehydration that we deal with as pediatricians.

What can cause diarrhea?
DANIEL NEUSPIEL, MD: The most frequent cause of diarrhea in infants is rotavirus. It's a virus that occurs all over the world, and it's quite contagious.

Does formula-fed versus breast-fed play a factor?
STEVEN SCHWARTZ, MD: Some breast-fed infants-particularly when they are older than a month of age-may have one stool a week. Others will have ten stools a day. Again, each child will generally develop his own pattern. And that pattern-if it changes-is something to be looked at and considered as if it's a manifestation of a problem.

Formula-fed infants tend to have firmer stools. This is largely a consequence of the different kinds of bacterial flora that are in the bowel of breast-fed versus bottle-fed infants.

Before we move on with diarrhea, let's mention vomiting. Is it normal in newborns or older children, and what causes it?
STEVEN SCHWARTZ, MD: True vomiting is never really normal. Young infants will have some spitting up after feeding, and that's okay. But if a child is truly vomiting large amounts-particularly if it's projectile or forceful-this is always a concern.

What other accompanying symptoms might we see with vomiting that could be serious?
STEVEN SCHWARTZ, MD: Well, the most important, potentially life-threatening situation would be if the vomitus turns greenish. That suggests that it's coming from lower down in the intestine, and it may represent an obstruction.

A child who forcefully vomits can have a gastric problem, or an infection.

What are the danger signs for dehydration?
DANIEL NEUSPIEL, MD: It depends on the age of the child. But when we deal with an infant, where dehydration can be most concerning, we look early on for things like fewer wet diapers. Sometimes that's hard to tell these days, with the super absorbent disposable diapers, but most parents can get a rough handle on that.

Also, looking for dryness around the mouth is important. A later sign, a more serious sign, might be if a baby's eyes seem sunken inside the head.

STEVEN SCHWARTZ, MD: Also, when a child gets significantly dehydrated, he tends to become listless, almost lethargic. If your child goes from irritable to listless, and continues to have symptoms of vomiting and diarrhea, that's a real danger sign.

DANIEL NEUSPIEL, MD: Dehydration can occur very quickly, especially in young children. And when there is vomiting with diarrhea, we usually have to pay attention to the vomiting first, because no matter whether the diarrhea's continuing or stopping, if the child's vomiting, then he or she is going to get dehydrated if it doesn't stop.

What should parents do?
STEVEN SCHWARTZ, MD: Well, again, a lot depends on age. I think the child less than three months of age should always be seen by a pediatrician.

What about the older kids who have diarrhea and vomiting?
DANIEL NEUSPIEL, MD: I try to get some information when I get a call from a parent who has a child with vomiting and diarrhea. Not just the age of the child, but also the frequency of the vomiting and diarrhea, and whether the child's able to retain any liquids by mouth. If a child is continuously vomiting and not keeping down any liquids, then that child has to be seen, no matter what the age. But if the child can retain some liquids and keep from getting dehydrated, he can often be managed at home.

There are some special liquids that are available for parents to use with medical advice to help prevent dehydration, especially in infants.

Like Pedialytes?
DANIEL NEUSPIEL, MD: Yes, that's one brand. There are various brands of oral electrolyte solutions. Basically, they are water mixed with some chemicals that retain fluid. They prevent dehydration, and are more easily absorbed than other juices and beverages.

STEVEN SCHWARTZ, MD: The high-sugar content of something like fruit juice can actually make diarrhea worse. So if you have an infant with gastroenteritis and you want to give them some liquid, use one of the oral rehydration solutions, don't use fruit juice.

Do you have any other advice about using electrolyte solutions?
DANIEL NEUSPIEL, MD: One of the common mistakes that parents make is that they treat it as a medicine rather than a replacement fluid. We will commonly see parents giving these solutions in combination with the child's regular diet. When these solutions are used, they should be used as a replacement for anything else taken by mouth. And they should be used for a limited period of time only, generally just 24 hours.

STEVEN SCHWARTZ, MD: That's very important to emphasize. I have, unfortunately, seen some infants who come into the office being on one of the oral rehydration solutions for three or four days.

DANIEL NEUSPIEL, MD: Again, the bottom line is, if you are concerned about your child's state of dehydration, you should visit a physician.